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Chapter Four Mediative Formulae

All the mediative formulae have the harmonizing effect and are osed to treat Shanyang diseases, or syndromes of imbalance between the liver and spleen, or disharmony of gastro-intestines. They pertain to mediative therapy of the eight therapies.
in Treatise on Cold-Attack, mediative formolae are specifically designed for Shaoyang diseases. The gallbladder has the exterior-interior relationship with the liver and they are affected motoally when suffering from evils. Besides, diseases of the gallbladder and liver osually involve the dysfonetion of the spleen and stem ach. Therefore, in addition to formulae fur mediating Shaeyang, there are mediative fornuilae for harmonizing the liver and spleen, formulae for regulating gastro intestinal tract. There was a point of view that “malaria pertains to Shaoyang dis eoses” , so the formulae fur treotiog malaria were usually included iu the mediative formulae. But, malaria can be divided into a variety of types such as cold, heat, de ficiency and excess, the mediative formulae cannot include all of them. So the specific section for treating malaria is oot set up in this chapter.
Though the herbs in mediative formulae are that of harmonizing and dispersing wirh gentle property, they arc used tu expel evils and rectify deviation. So they cannot he applied to cases without Shaoyang diseases, no matter whether e vils are in the exterior or interior.
Section 1 Formulae for Mediating Shaoyang
Shaoyang mediating formulae arc suitable to Shaoyang diseases in which the evils, leaving the exterior uf Toiyaog but not catering the iuterior of Yangming, locate in the part of half exterior and half interior, During the fighting period be twecn the gcnuinc-qi and cvil-qi, chill and fever appear alternately, i.e. the exuberant geouioe qi leading to fever and the progressive evil to chill. Heat in the gall bladder causes the oral bitter taste and heat injuring body fluid results in dryness of throat. When heat disturbs upward along meridians, vertigo appears. Chest distress aod hypochondriac fulloess are due to dysfunction of the meridian qi of Shaoyang. The taut pulse reflects disorders of the liver and gallbladder. At this
time, diaphoretic, emetic and purgative therapies are inhibited. The only proper one is the mediative therapy. As the commonly used main herbs, bopleorom root and sweet wormwood act on the Shaayang Meridian to clear away and lo expel evil in the half exterior; while scotellaria rout is good at clearing away heat in the half interior.
The gallbladder is attached to the liver, so the gallbladder diseaaes usoally bring about stagnation of the livcr-qi. When the stomach is involved and the stomach qi fails in descending and harmonizing, nausea or vomiting appears. in this case, pinellia tuber, fresh ginger and tangerine peel can be used togethor to harmonize the stomach for relieving vomiting. Disharmony between the spleen and stom ach can easily lead to production of damp heat and phlegm, aa bamboo shaviags:
bitter orange and red porin can be used to clear the stomach and resolve phlegm. if the Shaoyang diseases affect Yangming with manifestation of persistent vomi ting , depressinri with slight vexation and cc supauno, then rhoharh , inirabilite and onripened bitter orange should be used to purge the interior accumulation of heat. in order to support the genuine qi and expel the evil qi in the condition of struggle between the genuine and evil in the place of half exterior and half interior, pilosc asiabell root, Chinese date and licorice root can he used. The representative formo lae are Minor Ilopleurom Decoction, Major Bopleorom Decoction, Sweet Worm wood and Scutelleria Gallbladder-Clearing Decoction, etc.
Minor Bupleurum Decoction
xido chái ha tang
SOURCE:Treetise on Cold Attack
Bopleorom root i2g
Scotellaria root 9g
Ginseng 6g
Pinellia tuber 9g
Roasted licorice 9g
Fresh ginger 9g
Chinese ilaW 4 pee.
DIRECIIONS:Dccoct the above herbs in water for oral edministretion.
EFFECT: Harmonizing Shaoyang.
(1) Shaoyang syndrome of cold-attack menifested by alternate chill and fe
ver, chest distress and hypochondriac fullness, depression with poor appetite, vexatian with liability of vomiting, oral bitter taste, dryness of throat, vertigo, thin and white coating, and taot pulse.
(2) Heat invading the blood compartment of female due to cold attack, and miscellaneous diseases as malaria, jaundice and internal injury with symptoms of Shaoyang diseases.
ANALYSIS OF FORMULA: This is a representative formula for harmonizing Shaoyang. As the main herb, bupleurum root clears heat from Shaoyang and soothes the liver for relieving depression, so as to disperse the evil out from the half exterior. Seotellaria rout acts as the assistant herb to clear away heat from the half interior of Shaoyang. The cooperation of these twa herbs plays role of exteri or-expelling and interior-clearing so as to mediate Shaoyang. Ginseng, Chinese date and licorice root can invigorate qi and regulate the middle to expel evil and prevent its invasion by means of supporting the genoine-qi. Pinellia tuber and fresh ginger can harmonize stomach to lower, the rebellious qi; fresh ginger and Chinese date can harmonize the nutrient and defensive qi as well as mediate cold and heat. They all act as the adj avant herbs. Licorice root as the dispatcher herb harmonizes all components of the formula.
Clinically, this formula has very extensive appliestion. In addition to Shaoy ang syndromes, it can be applied by proper modifications to malaria,jaundiee, wind attacking on woman after delivery or daring menstruation or heat invading the blond compartment doe to cold-attack.
Because bopleoram root has the properties of ascending and dispersing, this formula is not suitable to eases of hyperactivity of yang doe to yin deficiency.
Bopleurom, Orange and Platyeodon Decoetion cehdi ha aM já tang) , (Re vised Popular Treatise on Cold-Attack)
Bapleururn root 4g, bitter orange 4. 5g, pinellia tober parched with fresh ginger juice 4. 5g, fresh ginger 3g, seutellaria root 4g, platyeodon root 3g, tangerine peel 4. 5g, early spring tea 3g.
Indications: alternate chill and fever, pain of forehead angles, deafness, vertigo, distending pain of chest and hypoehondrium, white and slippery coating, taot and slippery polse of the right hand and toot, floating and large pulse of the left hand.
NOTES: This formula is composed of Minor Bopleoram Decoetion by remo86
ving ginseng, licorice and Chinese date and adding bitter orange, platycodon root, tangerine peel and tea leaf. The emphasis is laid on regulating the ascending and descending activities of qi. So it is used to treat the exterior and suitable to the meridian disease of Shaoyang to disperse the half exterior.
Major Bupleunim Decoction
dà chái ha tang
SOURCE:Treatise on Cold Attack
Bupleurum root 9g
Scotellaria root 9g
White peony root 9g
Pinellia tuber 9g
Fresh ginger 9g
Unripened bitter orange 9g
Rhubarb 6g
Chinese date 4 pes.
DIRECTIONS:Uecoct the above herbs in water for oral administration.
EFFECTS: Expelling Shaoyang evil exteriorly and purging heat accumulation interiorly.
INDICATIONS: Combination of Shaoyang and Yangming diseases manifested by alternate chill and fever, chest distress and hypochondria fullness, persistent vomiting, depression with slight vexation, stuffiness and hardnss of epigastrioni, or distending pain of epigastriom, constipation, or diarrhea with fever, yellow coating, taut end forceful pulse.
ANALYSIS OF FORMULA: This formula is a modification of the Minor Bopleuruni Decoetion and Minor Purgative Decoction for treating the combination of Shaoyang and Yangming diseases. As the main herbs, bopleurum root and scotel lana root harmonize Shaoyaog. Being the assistant herbs, rhubarb and unripened bitter orange purge the excessive heat of Yangming to prevent from transforming into excessive syndrome of Yangming fe-viscera due to heat evil entering the in tenor thoroughly. Being sour flavor and cold nature, white peony root can not only clear the gallbladder and liver for regulating qi and blood by cooperating with bopleorem root and seutellaria root, but also relieve spasm and pain by cooperating with rhubarb; fresh ginger is to harmonize stomach for lowering torhidity by cooperating with pinellia tuber as well as harmonizing the nutrient and defensive
qi and all the eorrlporienls by cooperating with Chinese date. They act as the adju— vant and dispatcher herbs together.
Sweet Wormwood and Scutellaria Gallbladder-Clearing Decoction
Mo qin qing dan tang
SOURCE:Revised Popular Treatise an Cold Attack
Swcct wormwood 6g
Bamboo shavings 9g
Pinellia tober 5g
Red poria 9g
Scutellaria root 8g
Bitter orange 5g
Tangerine peel 5g
Green Jade Powder 9g(namely powder of talc, licorice and natural indigo)
DIRECTIONS:Decoct the above herbs in wster for oral administration.
EFFECTS:Clearing the gallbladder and harmooizing the stomach by resolving dampness and phlegm.
INDICATIONS: Malaria-like chill and fever with heavier chill and lighter fever, oral bitter taste, distress of diaphragm, acid regurgitation, or vomiting with yellow mucous saliva, even retching and hiccup, distending pain of chest and hypa— chondrium. red tongue with white and greasy coating, slippery and rapid pulse of the right hand and taut and rapid pulse of the left hand.
ANALYSIS OF FORMULA:Being hitter flavor and cold nature with aromatic property, sweet wormwood is good at clearing away damp heat from the gallblad der and liver; scutellaria root can clear away heat from the gallbladder. They both act as the main herbs. Being sweet flavor and cool nature, bamboo shavings clears the gallbladder and stomech to relieve vnmiting;tengerine peel, pinellia tuber can dry dampness and resolve phlegm as well as regulating qi for harmonizing the stomach ;bitter orange activates qi to remove eccumulation.They are the assistant herbs together. As the adjuvant and dispatcher herbs, red poria and Green jade Powder can clear away heat and facilitate diurisis to conduct the gallbladder heat downwards, in which the licorice root harmonizes all the components.
Section 2 liotniulae for 1-larmonizing the Liver and Spleen
Formulae for harmonizing thc livcr and spleen arc indicated to syndrorncs of
failure of the liver dispersing function which is caused by stagnated liver qi inva ding the spleen and stomach transversely or failure of die spleen in transporting with retention of earth and stagnation of wood. The liver dominates dispersion, likes flourish and smooth as well as stores blood. Depressed emotion leads to fail ore of qi io ascending and descending end stagnotioo of the liver-qi, so there are syroptonis of distending pain of hypochondrium, inclination to sighing, reticence aod depression, irregular ioeostruotion, etc. Stagnatioo of yaog qi cao results io cold limbs of heat type. The liver-qi invades the spleen and stomach traosversely causes tired mind, poor appetite, diarrhea, intestinal soond with abdominal pain, etc. All these should be treated by harmoniziug the liver sod spleen. For the stag nation of the liver-qi, bupleorom root should be used as the main herb to disperse the liver-qi If accompanying blood deficiency, Chinese angelica root and white peony root should he used cooperatively to gentle the liver sod nourish blood in or der to give consideration to the liver nature of substance pertaining to yin with function of yang. For the severe case of the liver stagnation with the spleen deficiency, bighead atractylodes rhizome and white peony root can be used together to act as the assistant herbs.
For dampness doe to the spleen deficiency, pnria could be added to excrete dampness and strengthen the spleen;for stagnatioa of qi, tangerine peel, onripened bitter orange and notgrass flatsedge rhizome could be used cooperatively to regulate qi and harmoroze the middle as well as soothing the liver for relieving depression; for qi stagnation with blood stasis, choanxioag rhizome, red sage rant, peach kernel and safflower could be used together to activate blood and resolve stasis. The representative fnrniulae are Cold Limb Powder, Merry Life Powder, etc.
Cold Limb Powder
iii ran
COURCE:Treatise on Cold-Attack
Roasted licorice rant 6g
Unripencd bitter orange 6g
Bopleorom root 6g
White peony root 9g
DIRECTIONS:Deeoct the above herbs in water for oral administration.
EFFECTS: Expelling evils and relieving stagnation, soothing the liver to rego89
late spleen.
INDICATIONS:Shaoyin diseases manifested by cold limbs, or cough, or palpi tation, or disuria, or abdominal pain, or diarrhea with tenesmus.
ANALYSIS OF FORMULA: This is originally a representative formula for cold limbs of heat type,but now it is extensively applied to hypochondriac and abdominal pain due to disharmony between the liver and spleen. Buplcorum root can soothe the liver for promoting the functional activity of qi as well as dispelling the stagnated heat. White peony root is to nourish blood for gentling the liver and re lieving spasm and pain. They both act as the main herbs. As the assistant herb, ooriptned bitter orange lowers qi to relieve stuffiness. The cooperation of bupleurum root and uoripened bitter orange can regulate the functional activity of qi to dispel the stagnated heat with both ascending and descending. Licorice root is the dispatcher herb to harmonize all the components. By cooperating with white peony root, it can also relieve spasm snd pain.
In the present clinic, it is applied to chronic hepatitis, ascariasis of biliary tract, pancreatitis and intercostal neuralgia, etc.
Bopleurum Liver-Soothing Powder chdi ha situ gun san), (Jingyue’s Complete Works)
Tangerine peel 6g; bupleurum root 6g; chuanxiong rhizome 4. 5g; notgrass flatsedge rhizome 4. 5g; bitter orange 4. Sg white peony root 4. 6g Roasted licorice root LEg.
The above herbs should he decocted in water for oral administration. Effects:
soothing the liver and activating qi for harmonizing blood and relieving pain. Indications: hypochondriac pain with alternate chill and fever.
NOTES: This formula is based on Cold Limbs Powder by removing onripened bitter orange and adding tangerine peel, bitter orange, ihuanxioog rhizome and nutgrass flatsedge rhizome, so the effect of activating qi and harmonizing blood is strengthened. It is mninly applied to hypochondriac pain doe to stagnation of the liver qi.
Merry Life Powder
xido yáo san
SOURCE: Formulae of Peaceful Benevolent Dispensary
Bopleurum root 9g
Chinese angelica root 9g
White peony 9g
Bighead stractylodes rhizome 9g
Poria 9g
Roasted licorice root 4. 5g
DIRECTIONS: Decoct the above herbs in water with small amoont of baked ginger and peppermint for oral administration.
EFFECTS: Soothing the liver to relieve depression and strengthening the spleen to noorish the notrient qi.
INDICATIONS:Stagnation of the liver-qi with blood deficiency manifested by hypochondriac pain, alternate chill and fcver, headache with vertigo, dryness of mouth and throat, lassitude, poor appetite, irregular menstruation, breast disten tion, taut and feeble pulse.
ANALYSiS OF FORMULA: This is a common formula fur harmonizing the liver and spleen and a modification from Cold Limbs Powder. Bupleurum runt can soothe the liver for relieving depression; Chinese angelica rout and white peony root cnn nourish blood for gentling the liver. They act as the main herbs to take care of both the liver structure and function as well as regulating both qi and blood. As the assistant herbs, bighead atractylodes rhizome and poria strengthen the spleen and eliminate dampness to promote the generation of qi and blood. Snail amount of peppermint and barked ginger act as the adj avant herbs to assist the main herbs for dispersing. Licorice root is the dispatcher herb to reinforce the middle-qi and to harmonize all the components.
In the present clinic, it has certain curative effects against cascs of chronic hepatitis, chronic gastritis, neurosis and central retinitis pertaining to stagnation of the liver—qi with the spleen deficiency.
(1) Modified Merry Life Powder (ha tofi xzao ydo san) ,(Summary of Inter nd Diseases)
On the basis of Merry Life Powder moutan bark 3g and capejasmine fruit 3g are added. The above herbs should be decoeted in water for oral administration. Effects: soothing the liver and strengthening the spleen to harmonize blood and regulate menstruation. It is used in blood deficiency of the liver and spleen with transformed heat and fire manifested by vexation and being easy to be anger, sweating or night sweating, headache with dry feeling of eyes, or hectic cheek and
dryness of mouth, or irregular menstruation with lower abdominal pain, or pain of lower abdomen with tenesmic feeling, difficulty and pain in mieturition, eet.
(2) Merry Life Powder with Rehmannia thez .riao ydu san) , (Essential Gy necology of Six Books on Medicine)
On the basis of Merry Life Powder rehmannia root or prepared rehmannia root is added. Effects: nourishing blood to soothe the liver and strengthening the spleen to regulate menstruation. Indications: Blood deficiency of the liver and spleen marked by dysrnenorrhea with taut and feeble pulse.
Section 3 Formulae for Regulating Gastrointestinal Tract
Gastrointestinal tract—regulating formulae are suitable to syndrome of mixed cold and heat due to evils invading the gastrointestinal tract which leads to dysfunction in ascending and descending manifested by stuffiness and fullness of epigastrium and abdomen, nausea and vomiting, abdominal pain or bowel sound with diarrhea, etc. so it should be treated by the therapy of opening with pungent flavor and lowering with bitter flavor and with herbs of cold and hot natures simul taneously. The main herbs in common use are sculellaria root and coptis root cooperating with dry ginger and pinelha tuber. Because it is usually accompanied by qi deficiency of the middle, pilose asiabell root and Chinese dote can be used together. The repreSentative formula is the Pinellia heart-Purging Decoction.
Pinellia heart-Purging Decoction
bàn xià xiè xin tang
SOURCE: Treatise on Cold Attack
Pinellia tuber 9g
Scutellaria root 6g
Dry ginger 6g
Ginseng 6g
Roasted licorice root 6g
Coptis root 3g
Chinese date 4 pcs.
DIRECTIONS:Decoct the above herbs in water for oral adniinistration.
EFFECTS: Harmonizing the stomach and lowering rebellious qi to relieve stuffiness.
• 92
INDICATIONS:Disharmony of the stomach-qi manifested by stuffiness and fullness of epigastrium without pain, retching or vomiting, bowel sound with diar rhea, thin, yellow and greasy coating, taut and rapid pulse.
ANALYSIS OF FORMULA:This is a representative formula of the therapy to open with pungent flavor and lower with hitter flavor for the syndrome of mixed cold and heat. With pungent flavor to disperse coagulation and hitter flavor to stop vomiting, pinellia tuber is the main herb to act on the stomach and spleen for drying dampness. As the assistant herhs, dry ginger is to warm the middle for dis pelling cold;scotellaria root and coptis root arc to purge heal with their hitter fla vor and cold nature. They cooperate with the main herb to form the formula of openiog with pungent flavor and lowering with bitter flavor. Ginseng and Chinese date act as the ad] ovant herbs to invigorate the middlc-qi. Licorice root is the dis patcher herb to reinforce the spleen and stomach as well as harmonizing all the compnnents.
in the present clinic, this formula is used in acute gastmoenteritis, chronic gas tritis, dyspepsia and infantile toxic dyspepsia with the above mentioned symptoms.
(1) Ginger Hcart-Porging Decnction (sheng jiang ne xiii tang) , (Treatise an Cold—Attack)
On the basis of Pinelba I leant-Purging Decnctinn the dosage of dry ginger is reduced from 6 gram to 3 gram and fresh ginger 12g is added. Effects: harmoni zing the stomach to disperse stuffiness and water accnmolation. Indications: the combination of water and heat evils manifested by stuffiness and hardness of epigastriom, eructatinn with fetid odor, thundering horharygmus, diarrhea, etc.
(2) Licorice heart Purging Decoctian (gun cáo xiC xiii tang) , (Treatise on Cnld Attack)
On the basis of Pinellia heart-Purging Decnctinn the dosage of licorice is increased from 6 gram to 9 gram. Effects: rein fnrcing the stomach qi to relieve stuff mess and stop vomiting. Indications: deficiency of the stomach qi manifested by thundering borhorygmnus, diarrhea with undigested •food, stuffiness, hardness and fullness of epigostriom, retching, vexation and restlessness, etc.
(3) Coptis Decoction(hudng han lang) , (Treatise on Cold-Attack):
Coptis rnot 6g, Roasted licorice rnot 6g, dry ginger 5g, cassia twig 5g, ginseng 3g, pinellia tuber 9g,Chinese date 4 pcs.
Effects equally harmonizing cold and heat to regulate stomach qi and lower rehellioos qi. Indications: heat in chest and cold in stomach manifested by irritable distress of chest,tendency of vomiting, abdominal pain, or bowel sound with diar rhea, whitc end slippery coating, taut pulse.
NOTES: All the Pinellia Heart-Purging Dccoction, Ginger heart-Purging Dccoction, Licorice Heart Purging Decoction and Coptis Decoction are formulae to harmonize cold and heat by opening with pungent flavor and lowering with bitter flavor. Applying herbs of both cold and hot natures, Pinellia Heart-Purging Dc cuction is mainly applied to symptoms of epigastric stuffiness, retching, bowel sound with diarrhea; Ginger Heart-Purging Docoction can harmonize the stomach and disperse water and is mainly applied to the joint attack of water evil and heat evil manifested by retching with fetid odor, thundering horhorygnius with diarrhea, so adding the fresh ginger to disperse water; Licorice Ileart-Purging Decoction can reinforce the stomach—qi to relieve stuffiness and is mainly applied to severe deficiency of the stomach-qi due to erroneous purgation manifested by vexation and restlessness, serious stuffiness of epigastrium, so increasing the dosage of licorice root for reinforcement ; Coptis Decoction can harmonizes cold and heat equal ly and is mainly applied to symptoms of irritable feverish sensation in chest, vomiting and abdominal pain, so removing scutellaria root from Pinellia Heart Purging Decoction and adding cassis twig to disperse the stomach cold.
In Summary
There arc totally6 mediative formulae. According to their different effects, they are divided into formulae for mediating Shaoyang, formulae for harmonizing the liver and spleen, and formulae for regolating gastrointestinal tract.
1 Formulae for mediating Shaoyang
The Minor Bupleurom Decoction is the representative formula for mediating Sheoyong, in which bopleorom root and scotcllaria root are the main herbs to expel exogenous evils while ginseng and licorice root can support the genuine to dis pd the evil. The Major Bupleurum Decoctioo is mainly applied to Shaoyang diseases complicated with excessive syndrome of Yongming fe-viscera, in which boplcorum root and scotellaria root are cooperated by unripened hitter orange and rhoharh to relieve Shaoyoog exteriorly and purge the accumulated heat interiorly. The Sweet Wormwood end Scotellaria Gallbladder-Clearing Decoction is applied to syndrome of damp heat and phlegm turbidity acciimulatiog in Shaoyoog marked by heavier fever and lighter chill, so sweet wormwood and scutellerie root are used

as the main herbs with the aromatic property to resolve turbidity for clear Shaoyang. Meanwhile cooperating the herbs for clearing heat and dampness as well as activating qi and resolving phlegm.
2. Formulae for harmonizing the liver and spleen
The Cold Limbs Powder is applied not only to cold limbs of heat type due to invasion of the liver qi on the spleen resulting in stagnation of yang-qi but also to disharmony between the liver and spleen manifested by epigastrie and abdominal pain, diarrhea with teuesmus, in which bupleurum root and white peony root are used as the main herbs to soothe the liver and nourish blood. Syndromes indicated by Life Powder is caused by stagnation of the liver-qi, blood deficiency and spleen deficiency, in which the key is stagnation of the liver qi with blood deficiency, so the herbs are chiefly to nourish blood and soothe the liver.
3. Formulae for regulating gastrointestinal tract
The Pinellia Heart-Purging Deeoetiun is the representative formula for open ing with pungent flavor and lowering with bitter flavor, in which the herbs of cold and hot natures ane used simultaneously, su it is used to treat syndromes of the joint attack of cold and heat evils with dysfunction of qi ascending and descending manifested by stuffiness and hardness of epigastrium, vomiting and diarrhea.


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